Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis.

Autor: Arjomandi Rad A; Medical Sciences Division, University of Oxford, Oxford, UK., Zubarevich A; Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany., Shah V; Department of Medicine, Faculty of Medicine, Imperial College London, London, UK., Yilmaz O; School of Postgraduate Studies, Royal College of Surgeons of Ireland, Dublin, Ireland., Vardanyan R; Department of Medicine, Faculty of Medicine, Imperial College London, London, UK., Naruka V; Department of Cardiothoracic Surgery, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK., Moorjani N; Department of Cardiothoracic Surgery, Royal Papworth Hospital, Royal Papworth Hospital NHS Trust, Cambridge, UK., Ruhparwar A; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany., Punjabi PP; Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College Healthcare NHS Trust, London, UK., Weymann A; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2023 Aug; Vol. 47 (8), pp. 1250-1261. Date of Electronic Publication: 2023 Apr 22.
DOI: 10.1111/aor.14549
Abstrakt: Background: Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear.
Methods: A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection.
Results: Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed.
Conclusion: LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
(© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
Databáze: MEDLINE
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